What Are the Complications of Diabetes?
The physical complications fall into two groups: microvascular (involving small blood vessels) and macrovascular (involving
large blood vessels). In general, people with type 1 diabetes tend to have problems with small blood vessels at first, but
not always. Complications with type 2 diabetes tend to involve the large blood vessels. This following information can be
scary to read. But the more you know, the more you can do to prevent these common complications of diabetes.
Microvascular complications occur only in people with diabetes. They include:
Macrovascular complications also occur in the general population, but they are much more common in people with diabetes. They
include:
Remember, though, that not everyone with diabetes develops these problems.
These complications almost never happen in young children and they are not common in teenagers. However, diabetes probably
starts to have an effect from the time it begins. The impact may be somewhat less before puberty, but early changes seem
to speed up during adolescence. Keeping up a good blood sugar balance right from the time of diagnosis will add to overall
long-term health.
Risk factors for complications
In the following situations, a person’s risk of having complications is higher.
-
How long a person has had diabetes: Complications are rare in those who have had the disease for less than five years, and
before puberty. After that, the longer a person has had diabetes, the more likely it is that complications will arise.
-
Poor blood
glucose control: The Diabetes Control and Complications Trial showed that long-term blood sugar control, and both
the start and progression of diabetes-related complications, are closely related. This trial showed clearly that control
counts. Excellent
blood glucose control reduces the chance that complications will develop. However, that doesn’t mean that
someone with poor control will definitely have complications. It also doesn’t mean that someone with excellent control is
guaranteed not to have them.
-
Smoking: Many studies show that smokers with diabetes are at much greater risk of developing complications than non-smokers.
Those complications will also worsen more quickly than with non-smokers. Giving up smoking reduces the risk a great deal.
-
High
blood pressure: People with diabetes who develop high blood pressure (
hypertension) are at high risk of complications.
This is because of increased pressure on the kidneys, heart, and blood vessels. Lowering the blood pressure with aggressive
medical treatment reduces this risk. Regular blood pressure checks are an essential part of diabetes care.
-
High blood fats (lipids––cholesterol and triglycerides): People with poor blood glucose control develop high blood fat levels
(
hyperlipidemia). Some people are born with a tendency to develop high blood fat levels. In both cases, these high levels
add to the risk of complications. Screening for high blood fats is another important part of diabetes care.
-
Obesity: People who are very overweight have a greater risk of macrovascular complications. Weight control may be a difficult
challenge for teens and adults, especially girls.
Blood glucose and complications––what’s the connection?
We know that persistently high blood glucose levels are associated with a higher risk of complications. However, the connection
between the two is still being heavily researched. It’s likely that a number of different processes are involved. For example,
glucose sticks to many proteins (the same way it sticks to hemoglobin, leading to the formation of HbA1c). Over time this “sticking“ may change the way some proteins function and damage different tissues. This is called the
glucotoxicity theory.
High blood sugar levels also affect the rate at which certain molecules are produced or removed from tissues. As a result,
there may be fewer molecules that are needed for the tissue to function. Or, there may be a build-up of molecules that damage
tissues. Some tissues affected this way are the nerves and the lens of the eye.
When poor blood glucose control leads to high levels of fat in the blood, that fat may build up in the arteries. This can
cause arteriosclerosis (hardening or the arteries). This is a major risk factor for macrovascular diseases such as heart attack
and stroke. People with diabetes are more likely to develop high blood pressure. This increases the risk of atherosclerosis.
It is also in itself a risk factor for macrovascular disease.
Screening for Complications
Once puberty has started and your child has had diabetes for three to five years, screening for complications and risk factors
should begin. This is important even though complications are rare in children and also in teenagers. If no problems are
found, that’s reassuring. If the early stages of complications are detected, interventions can be taken to prevent them from
developing, or at least to slow their progression.
Here are some blood and urine tests and examinations that your health care team will recommend on a regular basis. More frequent
testing will likely be advised if any problems are discovered.
|
Test/Examination
|
How Often
|
|
Blood pressure
|
every 3-6 months
|
|
HbA1c (to assess metabolic control)
|
every 3-4 months
|
|
Laboratory blood sugar against your own meter (to check your meter’s accuracy)
|
every 3-6 months
|
|
Thyroid function (thyroid stimulating hormone––to see if the thyroid is working too hard or too little)
|
every year
|
|
Blood fats (cholesterol and triglycerides)
|
3-6 months after diagnosis and, if normal, once again after puberty
|
|
Overnight or 24-hour urine collection for microalbuminuria, or albumin: creatinine ratio in a random urine sample(to detect
early diabetic nephropathy)
|
ever year after puberty begins and after having diabetes for 3-5 years
|
|
Eye checkup with ophthalmologist (to detect early diabetic retinopathy)
|
every years after puberty begins and after having diabetes for 5 years
|
|
Dental checkups
|
every 6 months
|
Screening for Complications (Type 2)
Screening for complications and risk factors should begin as soon as your child or teen is diagnosed, and each year after
that. This is important even though complications are rare in children and teenagers. If no problems are found, that’s reassuring.
If the early stages of complications are detected, interventions can be taken to prevent them from developing, or at least
to slow them down.
Here are some blood and urine tests and examinations that your health care team will recommend. They will likely advise testing
more often if any problems are discovered.
|
Test/Examination
|
How Often
|
|
Blood pressure
|
every year
|
|
HbA1c (to assess metabolic control)
|
every 3-4 months
|
|
Laboratory blood sugar against your own meter (to check your meter’s accuracy)
|
every 3-6 months
|
|
Blood fats (cholesterol and triglycerides)
|
every year
|
|
Overnight or 24-hour urine collection for microalbuminuria, or albumin: creatinine ratio in a random urine sample(to detect
early diabetic nephropathy)
|
every year starting at puberty
|
|
Eye checkup with ophthalmologist (to detect early diabetic retinopathy)
|
every year starting at age 15
|
|
Dental checkups
|
every 6 months
|
